On ‘The Far Side’ Of The Headache Diagnosis
Taxonomists of classification systems distinguish between clinical-symptomatic and etiologic approaches to disease classification. Clinical-symptomatic classification systems are based on symptom clustering and surface features, rather than underlying causes. Etiologic classification systems are based on underlying mechanisms and biology. As currently framed, the International Classification of Headache Disorders provides an etiologic classification for secondary headaches (e.g. cervicogenic headache) and a clinical-symptomatic classification for primary headaches. A clinical-symptomatic classification is based on a set of (unvalidated) signs and symptoms – it doesn’t indicate what we are dealing with; a primary headache diagnosis does not provide direction for physical therapists. Once a patient receives a headache diagnosis, their diagnostic process is not yet done. Perhaps it is more important to consider potential underlying musculoskeletal factors and pain mechanisms so as to optimize our influence on patients’ headache presentations. Hedwig will discuss not only how to recognize common headache complaints, but also how to look beyond them… what else matters in the diagnostic process?
Ms Hedwig van der Meer graduated from Hogeschool van Amsterdam with a Bachelor in Physical Therapy and then completed a Master in Physical Science at the University of Utrecht in 2013. Hedwig is a physical therapist specialized in orofacial pain and headache, as well as a clinical health scientist from the Netherlands. In 2015 she received a personal grant from the Dutch Research Council (NWO) to carry out her PhD at the Academic Center for Dentistry Amsterdam in collaboration with the Amsterdam University of Applied Sciences, the University Medical Center Utrecht and the Radboud University Medical Center Nijmegen.
Hedwig’s research covers several projects regarding headache and temporomandibular disorders. She has published extensively about the association between headache and temporomandibular disorders, and diagnostic assessment of these complaints. Collaborating with dentists, neurologists and physiotherapy colleagues, ongoing projects are investigating the physical therapeutic process of patients with these two disorders in regards to preferred treatment and e-Health possibilities. This includes cross-sectional and longitudinal observational designs, systematic reviews and qualitative research methods.
In addition to research, she also sees patients one day a week and lectures at the bachelor program for physical therapy and teaches courses about headache, temporomandibular disorders as well as head and neck anatomy. Hedwig is a member of the Scientific Committee for Physical Therapy (WCF), from the Royal Dutch Society for Physiotherapy (KNGF). As a committee member, she represents early career researchers, helps organize several events oriented towards researchers and physical therapists, and is involved in the creation, reviewing and distribution of research grants.